My Life With Adrenal Insufficiency

Having My Cortisol Day Curve Test

cortisol day curve

Well Yesterday I had a Cortisol Day Curve Test. What on earth is that you may ask? Well I’ll begin by talking a little about the Stress Hormone known as Cortisol.

Cortisol and the Cortisol Day Curve Test

Cortisol is produced by the Adrenal Glands in the body and it is an essential hormone needed to maintain blood pressure, help with blood sugar control and to keep the body alive.

cortisol day curve

When one is Adrenal Insufficient they cannot produce enough cortisol to enable the body to function normally and that places this unlucky person at risk of Adrenal crisis and death.

When you don’t make enough Cortisol, you need to put Cortisol in the body. This is most commonly done by taking hydrocortisone or prednisone tablets. These steroid tablets put Cortisol into the body temporary and replace the Cortisol the body is unable to make for itself.

The Cortisol Day Curve is a test where your blood is drawn every hour or so throughout the day to see if the Medication you take is replacing the body with the correct amount of Cortisol. The body requires different amounts of cortisol at different times and this can change when placed under stresses.

The Cortisol day curve can help determine if the medication your on is under or over replaced at different times of the day. This can help an Endocrinologist to make a more accurate dose schedule for an individual or see if one is not absorbing medication properly in which case the patient will need more medication or possibly injections.

My Experience having a cortisol Day Curve

In the past I have had two Cortisol Day Curves. They were started around 9am and ended about 4. This worried me because the test is supposed to measure before and after medication is taken and I take medication at 5pm so ending the test before 5 for me has never given an accurate result. The thing is, at the Day Treatment Center where I had my test done, the centre closes at 4pm, therefore the Nurses have always cut short my test.

This time however, I went to Manchester Salford Royal and I had the full Day Curve test for the first time ever. It began at 9am and ended at 7pm, two hours after my final daily dose of medication.

In a dream world, I would have my cortisol tested over 24 hours but not many NHS hospitals appear to do that. I am grateful I finally got a whole day curve test rather than 9-4.

I was cannulated early in the morning when I arrived and my first lot of blood was taken. Now before the test I was asked not to take my medication the evening before the test. This meant that the first blood draw can show my basal pituitary function…and show what my hormone levels are like on no medication. Also, this can show the Doctor how much if any Cortisol I am able to produce on my own.

Some people will Addison’s cannot make any Cortisol at all however secondary Adrenal Insufficiency patients may make some cortisol but it is often still far too little.

Last time I had a day curve over a year and a half ago, I was told I had made some Cortisol on my own but not enough for me to function or be well. This however was really different to 3 years ago so I am intrigued to see what is happening with my Cortisol levels at the moment.

Despite making some Cortisol my Endocrinologist told me I will always need to take Cortisol/ hydrocortisone medication and a minimum of 20mg.

I often feel very unwell around the time my medication is due. This is in my mind for two reasons.

  1. Hydrocortisone tablets take an hour or longer to absorb and drops out of the system after 5 hours. Once it’s dropped out I get symptoms of low Cortisol.
  2. I believe I have issues absorbing cortisol in the first place via my stomach. I think i absorb different amounts depending on what I eat and drink and that makes me unwell.

The test was long and boring but it needed to be done and im glad its over.

Taking Medication six times a day

My Endocrinologist set me up to take my medication 3 times a day at 8am, 12pm and 5pm. I have been told if I split it up over 6 times a day it would be better for me, however every time I attempt to do this, I catch a virus or get a period or become unwell and have to double up and I go back to what i know best 3 times a day.

My Endo told me to try and wake up 2 hours before I get up to take my medication to help me. You see my Blood pressure drops in the morning when my cortisol should be high but is really low. It takes time for the medication to work so no matter what time I take it I will feel unwell for 2 hours and then fatigued throughout the day once my medication has kicked in.

The problem I have is I have tried and cant wake myself up two hours before I am due to get up. I struggle. I am like a dead weight, unable to think straight in the morning and too weak with a low Blood pressure. I set my alarm, but don’t hear it. I put my medication at the side of the bed and make every effort to try and do this but it’s really hard.

I’m also supposed to take meds at 4am when I’m double dosing or unwell if I can but it’s not something I can get used to. I would like an adrenal pump to help me so I don’t have to wake in the night and to help release the medication more accurately throughout the day. I just cant get into a  six times a day schedule no matter how hard I try and I think it’s because of how unwell I am.

If you struggle to remember to take medication due to brain fog and concentration issues and have exhaustion and low bp and you need reminding three times a day to take your medication, then you would also need reminding 6 times and in the night or before you wake. It feels impossible but I will keep trying.

I cant pay for a carer to come and wake me. Doctors know 6 times a day is better but as my Endo said, it is often really difficult for a patient to take medication that many times and during their sleep so they set it at 3 times which is less optimal and as a result we have fatigue and exhaustion.

The adrenal pump would really help with this Issue for me but again this is not available to everyday AI folk and is a challenge to get hold of but it would certainly help with memory issues and taking medicine during the night.

I know I went a little off topic but I’m hoping the day curve can show what I need and that eventually I can get an adrenal pump to help me better manage this condition. I will keep trying to get my daily dose split six times a day but it is really hard to do this when I’m sick and often too unwell to think and work out what to do. The Adrenal pump could split this even better and more accurately!

The Cortisol Day Curve is the best test I’ve had in about one and half years and I’m looking forward to the results. It was not fun but was needed!

10 Comments

  1. Hi Angela, I had a day curve done recently, but just a half day one, but it yielded very telling results. It is a very valuable test. It revealed I metabolise my medication in just over two hours. It peaks at 2 hours then takes a nose dive. So, I have been dosing 3 hourly, 7 times a day, and have alarms going off all the time. Still, 3 hourly is not good enough, and my endo recommended the pump. It is happening in just over a week’s time!

  2. Can’t wait to see what the test results show. I’ve never had this test, so this was all very interesting to me. I do split my HC into 5 doses, starting at 6AM. I have my cell phone alarm set to go off, and if I sleep through the 6AM dose, my Hubby is still in bed, and will nudge me awake. It is hard to take meds so many times daily, but is worth it if you can do it. I take 30 mg HC daily…..can’t survive on less. I was diagnosed in 2001, and have tried so many things, this dosing is working for now. Keep us posted.

    mo

    Hope your surgery is healing well also.

  3. Thank you Angela
    very interesting.
    I may have to try splitting up my meds
    from 2 to 3 times a day.

    Thanks
    David

  4. Random question but did they take your gallbladder out when you had the bypass? I know some surgeons like to do this. The reason I ask,is I had mine removed 8yrs ago and have been problem free. One year ago, I had a pituitary tumour removed, leaving me with secondary adrenal insufficiency (hypopituritism). My endo consultant could never understand why I seemed well in hospital but so ill at home!? Long story short, turns out, due to having my gb removed, my pancreas wasn’t producing pancreatin properly. He started me on creon capsules which I take every time I eat or take my hydrocortisone etc helps my body break things down and absorb what I need. Other than the usual adrenal problems, I’ve been loads better x

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